Reinforcement mesh repair for persistent pleural leakage following VATS lobectomy: a case report and clinical...

Early chest drain removal and discharge are standard in enhanced-recovery protocols after video-assisted thoracoscopic surgery (VATS) lobectomy, but rare wound complications may arise. We report a 71-year-old man who underwent uneventful 3-port right VATS lower lobectomy. The utility access incision measured approximately 3.5 cm, was protected with a SurgiSleeve^® wound protector, and was closed in layers. No postoperative drain was placed through this site. The chest drain was removed on postoperative day 1 after absence of air leak and acceptable drainage output, and the patient was discharged on postoperative day 2. Two weeks later, serous pleural fluid leaked through the utility access wound. Conservative management with wound reinforcement, local compression, and empirical antibiotics failed. Re-exploration demonstrated clear pleural effusion without purulence, lung herniation, necrosis, or air leak. Selective reinforcement with polypropylene mesh anchored to the adjacent rib achieved wound stability, and the patient recovered without recurrence. Persistent pleural leakage through a VATS access wound is rare. In selected patients with persistent leakage after conservative management, and where infection has been reasonably excluded, mesh reinforcement may be considered as one feasible surgical option rather than a routine strategy.